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AvMed Medicare Access (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AvMed Medicare Access (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on AvMed Medicare Access (HMO-POS) in 2025, please refer to our full plan details page.
AvMed Medicare Access (HMO-POS) is a HMO-POS plan offered by Sentara Health Care (SHC) available for enrollment in 2025 to people living in Miami-Dade County. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that AvMed Medicare Access (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about AvMed Medicare Access (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For AvMed Medicare Access (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The AvMed Medicare Access (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions, which varies depending on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay at a preferred pharmacy or mail order, but a $15 copay at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The AvMed Medicare Access (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with no copay for most days, outpatient services with varying copays, and coverage for emergency services. This plan also covers primary care with no copay, preventive services with no copay, and offers vision and dental benefits with copays. Additional benefits include hearing services with copays, home health services with no copay, and coverage for medical equipment with coinsurance. The plan also provides coverage for ambulance services, and transportation to health-related locations with no copay. There are some services that are not covered, such as cardiac rehabilitation and certain types of hearing aids, so be sure to review the details carefully.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with no copay for days 1-5, and no copay for days 21-90, and a $40 copay for days 6-20 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric has a $150 copay for days 1-9, and no copay for days 10-90. Additional Days for Inpatient Hospital-Acute is covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a $225 copay, observation services with a $175 copay, and ambulatory surgical center services with a $75 copay. Individual and group sessions for outpatient substance abuse have a copay of $15, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the AvMed Medicare Access (HMO-POS) plan with a $15 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, and transportation services to plan-approved health-related locations. Ground ambulance services have a $165 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location have no copay, and are limited to 12 one-way trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered. Emergency Services have a $120 copay, Urgently Needed Services have a $20-$50 copay, and Worldwide Emergency Coverage has a $120 copay. Worldwide Urgent Coverage has a $50 copay, but Worldwide Emergency Transportation is not covered.
Primary Care See details
The AvMed Medicare Access (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $5 copay, occupational therapy services with a $15 copay, physician specialist services with a $15 copay, mental health specialty services with a $15 copay, podiatry services with a $5 copay, other health care professional visits with a copay between $0 and $15, psychiatric services with a $15 copay, physical therapy and speech-language pathology services with a $20 copay, telehealth services, and opioid treatment program services with a $15 copay. Routine chiropractic care is not covered.
Preventive Services See details
The AvMed Medicare Access (HMO-POS) plan covers preventive services with no copay for annual physical exams, and additional services like health education, fitness benefit, and remote access technologies. Other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. In-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams with a $5 copay, fitting/evaluation for hearing aids, and prescription hearing aids (all types). Routine hearing exams, prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include routine eye exams and eyewear. Routine eye exams and eyewear have no copay. Eyewear includes contact lenses, eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered. The plan offers a combined maximum benefit of $350.00 every year for all eyewear.
Dental Services See details
The AvMed Medicare Access (HMO-POS) plan covers various dental services. Medicare Dental Services have a copay between $15 and $225, while Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services have copays ranging from $0 to $45. Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with copays between $0 and $700. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by AvMed Medicare Access (HMO-POS) with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits are covered by AvMed Medicare Access (HMO-POS). Durable Medical Equipment (DME) has a 20% coinsurance, while Prosthetic Devices have no copay. Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $5 and $25, and lab services with no copay. Diagnostic radiological services have a copay between $50 and $100, therapeutic radiological services have at least 20% coinsurance, and outpatient X-ray services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the AvMed Medicare Access (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the AvMed Medicare Access (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by AvMed Medicare Access (HMO-POS), with a $0 copay for days 1-20, and a $135 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The AvMed Medicare Access (HMO-POS) plan covers Over-the-Counter (OTC) items with no copay, a maximum benefit coverage amount of $50 every three months, and Meal Benefits with no copay and prior authorization required. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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